Sports Medicine

Golfer's Elbow (Medial Epicondylitis)

Anatomy

The elbow is a complex joint that allows bending and straightening (flexion and extension), and forearm rotation (pronation, palm down; and supination, palm up). The elbow is formed by the joining of three bones: the upper arm (humerus), the forearm on the pinky finger side (ulna), and the forearm on the thumb side (radius). The surfaces of these bones, where they meet to form the joint, are covered with articular cartilage, a smooth substance that protects the bones and acts as a natural cushion to absorb forces across the joint. A thin, smooth tissue, called synovial membrane, covers all remaining surfaces inside the elbow joint. In a healthy elbow, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost all friction as you bend and rotate your arm.

Held together by muscles, ligaments and tendons, the elbow is a combination hinge and pivot joint. The hinge part of the elbow allows the arm bend like the hinge of a door, while the pivot part makes it possible for the lower arm to twist and rotate. There are several muscles, nerves and tendons that cross at the elbow.

Description

Medial epicondylitis, often known as golfer's elbow, is a painful condition that occurs when overuse results in inflammation of the tendons that join the forearm muscles to the inside of the bone at the elbow.

Causes

Participation in sports, work, or other recreational activities that require repetitive and vigorous motion may result in the overuse that leads to golfer's elbow. Although most commonly associated with golfers, pain in this area also occurs in children who play baseball. Many who are not athletes suffer from golfer's elbow.

Symptoms

Pain and tenderness on the inside of the elbow are among the most common symptoms of golfer's elbow.

Prevention

To avoid medial elbow pain, use the following simple exercises to help build your forearm muscles.

• Squeeze a tennis ball—Hold an old tennis ball in your hand and squeeze steadily for 5 minutes.
• Wrist curls—Lower a lightweight dumbbell to the end of your fingers, curl the weight back into your palm, then curl up your wrist to lift the weight an inch or two higher. Perform 10 repetitions with one arm, and repeat with the other arm.
• Reverse wrist curls—Place one hand in front of you over a lightweight dumbbell, palm side down. Using your wrist, lift the weight up and down. With your free hand, hold the arm you are exercising above the elbow to limit the motion of your forearm. Perform 10 repetitions with one arm, and repeat with the other arm.

Nonsurgical Treatment

Treatment for golfer's elbow (medial epicondylitis) is similar to that of tennis elbow (lateral epicondylitis). Many patients have success with nonsurgical treatment.

• Rest—Modify or discontinue participation in activities that aggravate the condition. Giving the arm proper rest is the first step toward recovery.
• Nonsteroidal anti-inflammatory medication—Drugs such as aspirin and ibuprofen may help reduce pain and swelling. Most people are familiar with these nonprescription NSAIDS, however, whether taking them in over-the-counter or prescription strengths, they must be used carefully. Using these medications for more than one month should be reviewed with your primary care physician. If you develop reflux or stomach pains while taking an anti-inflammatory, be sure to talk to your doctor.
• Physical therapy—Your doctor may recommend specific exercises to help strengthen the muscles of your forearm.
• Brace—Using a brace centered over the back of your forearm may help reduce symptoms by allowing muscles and tendons to rest.
• Steroid injections—Steroids, such as cortisone, are very effective anti-inflammatory medications and may be recommended for some patients.

Surgery

If your symptoms do not respond after 6 to 12 months of nonsurgical treatments, your orthopaedic surgeon may recommend surgical treatment. With any surgery there are some risks, and these vary from person to person. Complications are typically minor, treatable and unlikely to affect your final outcome. Your orthopaedic surgeon will speak to you prior to surgery to explain any potential risks and complications that may be associated with your procedure.